Expert: Catherine Ridenour - 3/18/2008

Question
QUESTION: I have a 4 year old boy, he bites his blankets, nails and anything that makes him angry.  he is very loving, but can act out and hit.  his teacher last year had me take him for an evaluation and did well.  this year we took him for another evaluation and they said his language is great but he needs speech therapy.  i am glad for that.  he can't express sometimes what he needs.  he talks about buzz lightyear all the time.  his imagination is incredible and is very artistic and can make anything out of play-doh.  
he just seems to not get it.  for example i cut the boys hair.  i asked my 2 year old what happened to your hair.  his reply.  i got a hair cut mom.  if i asked my other son(4 year old) he would say something like the sky is blue.  now this doesn't happen all the time.  the teachers asked me if he looks me in the eye.  i told them not all the time.  when he is trouble his eyes don't leave my eyes.  he pees and poops in his pants still.  he holds it and i have to tell him to go and use the bathroom.  he pooped at school the other day and the kids asked why is his mom here.  my son replied i pooped in my pants.  he just doesn't get things.  i am really wondering if this is normal.  he shows love like i said, but does hit if he thinks he may lose.  he will run and then push too.  he doesn't listen well.  i do take things away and it gets better then the same thing happens again. please if any suggestions.  he doesn't sit through dinner either, he's up and down.

ANSWER: Hi Kim,

My suspicion is that your son has Asperger's syndrome. This high-functioning autistic spectrum disorder primarily affects social function but also shows up in rigid speech patterns and a disconnect between the words and the message. He might also be diagnoses as PDD/NOS which is "pervasive developmental disorder not otherwise specified." This is kind of a catch-all diagnosis but the therapies are the same.

These kids can be loving toward parents yet totally unable to interact appropriately with their classmates and teachers. The root of this is that he does not realize that other people have thoughts and feelings. He also is not able to interpret his own emotions. He goes from happy to angry instantly because the build up goes unheeded.

Most of these children are emotionally younger than their body. He is probably working at the same level as his 2 year old brother. The good news is that he will progress so he won't be emotionally 2 forever.

Do start the speech therapy and talk to his pediatrician about an autism screening. Early intervention is crucial in helping him develop and learn as well as he can.

Here are a few parenting tips:

You are correct in using a form of discipline that attaches logical consequences to behavior. Keep it simple. If he breaks a toy, he does not get a replacement. No other punishment is needed. If he breaks his brother's toy, he needs to make reparation. This could be in the form of making his brother's bed or picking up some of his brother's toys.

If he has not been into tantrums, yet, be prepared to ignore them whenever possible. What gets attention is reinforced. Leave the room, don't give him an audience.

Hitting must not be tolerated and time-out is about the best way to make that point. He won't stay put long, so 4 minutes is all you should try to get. If he comes out too soon, just put him back. You have to be more persistent than he is.

Most of these children are overly sensitive to some things like high pitched noises, bright lights, strong odors or clingy clothing. Normal brains can screen some of this out, his can't. So, if he's acting out in a new situation, try to identify the factors in the environment that are setting him off. He's not wrong to have these issues, he can't help it and he can't turn it off. Offer him ways to cope such as ear plugs or a hat to shield his eyes.

Keep as much variety in his diet as possible. Letting him get fixated on french fries for three meals a day is a very bad idea. Constipation is common in these kids as they withhold their movements (I don't know why). Fruit and veggies are crucial.

Here are some web links where you can get more information. One specifically addresses toilet training.

http://groups.msn.com/TheAutismHomePage/toilettraining.msnw (toilet training)

http://www.neurodiversity.com/main.html (many links to books, articles and resources)

http://www.patientcenters.com/autism/news/resources.html (books and resources)

http://www.ninds.nih.gov/disorders/asperger/asperger.htm (the definitions and
government links)

http://www.autism.org/ (many links to information)

Best wishes,
Catherine

---------- FOLLOW-UP ----------

QUESTION: Catherine, thank youn for the quick response.  he is loving to teachers and even other kids too.  he just acts out with hitting.  he doesn't do tantrums.  he puts himself in time out if his brother crys.  i have to tell him, he isn't in time out.  i check out what happened and then do the time out.  his diet is great, he's a better eater then my 2 year old.  consisting of breakfast first thing in the morning, oatmeat, french toast, cereal, eggs whatever.  lunch we always do sandwiches turkey, bologna.  they aren't big on veggies except for spinach.  dinner basically what is good that they like.  chicken on the grill they both do.  so the food isn't an issue(thank goodness).  he loves to dance, lights don't bother him.  they both loved christmas.  clingy clothes are fine they still put costumes on including masks from halloween to play with his brother.  he can interact with other kids, he just uses his hands and not is words.  he can explain things if i get on him and say what's up buddy, tell mom what really happened at school today.  he walked up to his teacher last week she said and grabbed her hand and said your are so pretty. she thought he said you are so sweaty.  but he did tell her no pretty.  he did well with testing with all the colors alphabet,his address phone number.  who to call when there is an emergency.  so i just wanted to add this to the message.  loud music he loves.  even my music, he'll say mom this is your favorite song turn it up.  like i said it's on and off with him.  i even talk to his aid at school today and she said the hitting is normal for boys, they just need to learn to cope with it.  because one day they will be yound men.  
please let me know more of your thougts.  he's a charmer, the peditricians think he is normal and just young learning, but need to get the word articulation.  he tells the doctors all the symptoms when he goes in, so like i said on and off!!!!

Answer
Hi,

I'm glad you wrote back. Much of it is good news.

Still some things are consistent with Asperger's.

His understanding of "law and order" by putting himself in time out, his ability to recite the symptoms to the doctor, even his advanced ability to identify colors and to recall his emergency phone number are the kind of "little professor" behaviors seen in A.S. kids. They have terrific memories.

Hitting can be normal in 4 year old boys. Time will tell if this is a phase or indicative of an inability to express himself verbally. The biting if his hands and blanket are more in line with a spectrum disorder.

I think you are on top of most of this. Just watch for issues as they arise in school. If he begins to flounder socially, request an in depth evaluation.

Best wishes,
Catherine